Abstract
In 1993, after nearly 20 years of offering psychodynamic psychotherapy for individuals, couples, and groups in pastoral counseling and mental health centers I changed directions to establish a hospice-based community grief and bereavement center in upstate New York. Although I was an experienced clinician, there was much for me to learn about grief therapy and bereavement counseling to serve my new clients well. It was my good fortune that Research Press published two books that same year that were immeasurably helpful to me. One of those was Rando’s (1993) Treatment of Complicated Bereavement. The other was the first edition of Larson’s (1993) The Helper’s Journey, subtitled then as Working With People Facing Grief, Loss, and Life-Threatening Illness. I credit those two books with grounding me as a bereavement-focused professional.
Dale G. Larson, PhD, professor of Counseling Psychology at Santa Clara University in California, has made significant national and international contributions to end-of-life studies. One of those was his role as Senior Editor and contributing author for Finding Our Way: Living with Dying in America, a months-long nationally distributed newspaper series that educated millions of Americans about the realities of end-of-life care. It had long been scheduled to launch in the early fall of 2001, thus providentially appearing just as the United States was plunged into the trauma of the terror attacks of September 11. Larson has received awards as an educator and innovator by both the Association for Death Education and Counseling and the National Hospice and Palliative Care Organization. He is well regarded for his many presentations and publications in support of the hospice care model in the United States and beyond.
This second edition of The Helper’s Journey, after nearly 30 years, will be welcomed by both seasoned and newly launched caring professionals for its perspectives about functioning in the crucible of trauma, life-threatening illness, death, and loss. I particularly value Larson’s ability to write so personally and compassionately to the care-giving professional while bringing forward relevant research literature to strengthen and deepen the helper’s journey.
In Part 1, Exploring the Inner World of Helping, Larson details in four chapters the internal experiences of helpers. Those who regularly engage in caregiving will resonate with his appreciation that the deep satisfactions their work offers need not imply secret egotistical motives. He states that the prosocial exchanges involved in helping others are best understood as an experience of eudemonia, a Greek philosophic term for a happiness “consisting of the search for meaning and purpose in life beyond self-gratification” (p. 26). It is the opposite of hedonistic gratifications of happiness.
Further insight into the inner emotional workings of a helper is offered in a nuanced discussion of the distinctions between empathy-driven and distance-driven engagement with clients. Active professionals will recognize at least part of themselves in his exploration of downward and upward social comparisons, guilt, and shame as occasional clinical motivators. He also addresses the “interpersonal allergies” (p. 38ff) such as fear of our own death, fear of hurting rather than helping, and fear of being hurt or engulfed by our patients that can derail balanced empathic helping relationships. Since these and other stressors can contribute to burnout, Larson offers numerous for ideas for appraising stress and developing practices to discover and nurture resilience. The chapter on “Secrets: Concealment and Confiding in Helping and Healing” is significantly expanded from the prior edition, exploring the complex terrain of both hidden truths and self-disclosure on both sides of the helping relationship. This moves the typical topic of confidentiality in counseling texts to a much-needed higher level. Larson has done considerable research over the decades into the negative health consequences (physical and psychological) for both clients and clinicians of pronounced self-concealment. His admonition to clinicians that “we all need to have at least one … significant other in whom we can confide all our troubling thoughts and feelings” (p. 148) is, in my experience, a sine qua non for professionals functioning in end-of-life contexts.
Part 2, The Interpersonal Challenge, includes two chapters that lift up the foundational person-centered, positive psychological model that shapes Larson’s approach. He details what he terms the “microskills” that build toward effective listening and helping. Even experienced clinicians will find relevant insights into the qualities and attitudes that characterize effective helpers. It echoed for me the usefulness of Truax and Carkhoff (1967), Toward Effective Counseling and Psychotherapy: Training and Practice, in the earliest days of my own training. He is generous here and throughout the book with direct quotations and examples from work with clients and other helping professionals that vividly illustrate the keynotes of deep empathy, attentiveness, and caring that foster healing.
Part 3, The Caring System, offers an additional two chapters which appreciate the larger context within which each of us practices. As most clinicians will testify, it is not the work that burns us out, it is the frequent experience that “my supervisor and/or the administration drive me nuts and wear me out.” Except for the rare isolated private practitioner, human service professionals work in teams and within helping networks. The need to find wholesome approaches to conflict and build healthy, resilient team relationships is universal and ongoing. Larson targets the “fallacy of uniqueness” (p. 277) as a particularly egregious individualistic perspective that undercuts learning, support, and team health. It is an important insight to carry into our day-to-day work as caregivers. He offers concrete practices to counter this fallacy and promote team health.
As I write this review in late March 2020, the world reels from the insidious Covid-19 virus. None of us knows what our world will look like by the time this review is published. Hopefully the insights of Chapter 8, “Toward a Caring Society and World,” for creating a national and global caring community will prevail. It evoked for me the vision of Rilke, I live my life in widening circles/that reach out across the world/I may not complete this last one/but I give myself to it. Larson offers these ideas against the danger of “compassion collapse” (p. 292) in the face of such enormous suffering. But he deeply understands that a “transformation of our empathy into global compassion, guided by global ethics, is necessary to save ourselves and the Earth” (p. 296).
Yet despite that sobering vision, this book is optimistic, encouraging, and practical. It will be useful to medical, clinical, religious, and human service administrators who will find insight, affirmation, and challenge within it.